Providers should submit claims for mammography services based on the care that is provided. There are numerous scenarios for breast screening and follow-up based on technology used and diagnoses. To alleviate confusion, Blue Cross Blue Shield of North Dakota (BCBSND) proposes the following billing examples when digital breast tomosynthesis is used as part of a screening or diagnostic workup.
Bilateral Screening Mammography with Screening Digital Breast Tomosynthesis
- CPT® 77067 – Screening mammography, bilateral (two-view study of each breast), including computer-aided detection (CAD) when performed
- 77063 – Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure) (Use 77063 in conjunction with 77067.)
Diagnostic Mammography with Diagnostic Digital Breast Tomosynthesis
- CPT® 77065 – Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
- CPT® 77066 – Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
- G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
Digital breast tomosynthesis codes 77061-77062 should not be reported if 2D and 3D views have been taken. Instead, bill the appropriate mammography code (screening or diagnostic) with the appropriate tomosynthesis add-on code.
When billing an add-on code, it must be included on the same claim as the primary procedure. If the add-on code is billed on a separate claim, it will be rejected.
The appropriate ICD-10 diagnosis code should be used to reflect whether this was a screening or performed for a diagnostic mammogram.